Principles of Nutrition and Fluid Balance Nutritional needs and diet modifications

Nutrition Process by which the body takes in food for growth and repair and uses it to maintain health.

Signs of Good Nutrition Shiny hair clean skin and eyes well developed body alert expression pleasant disposition health sleep patterns appropriate appetite regular bowel habits body weight appropriate to height

Digestion Process of breaking down foods into simple substances that can be used by the body for nourishment; the substances are call essential nutrients

Essential Nutrients Body requires foods that: Six essential nutrients supply heat and energy build and repair body tissues regulate body function y requires foods that Six essential nutrients proteins carbohydrates fats minerals vitamins water

Protein sources Meat Poultry Eggs Milk cheese

Carbohydrates and fats Energy foods-used to produce heat and energy sources include fruit vegetables foods made from grains

Fats Plant and animal sources Examples of food that are rich in fat include pork butter nuts egg yolk cheese

Vitamins Substances that regulate body processes assist with…. Building strong teeth and bones promoting growth aid normal body functioning strengthening resistance to disease Vitamins used by the body

Minerals Build body tissues especially bones and teeth help regulate body fluids such as blood and digestive juices Mineral needed daily are Calcium, phosphorus, iodine, iron, copper, potassium

Five Food Groups US Department of Agriculture recommends Eating a variety of foods maintain a healthy body weight select foods low in fat, saturated fat and cholesterol select plenty of vegetables , fruits, and grain products use sugar in moderation use salt and sodium in moderation drink alcoholic beverages in moderation

Food Plate

Hospital Nutritional services Meal trays prepared by dietary department Includes essential nutrients Meals prepared according to patients needs Ordered by physician

Responsibilities during meals Prepare the patient for the meal Checking the food tray for correctness Checking the tray card against the patients identification Serving the tray to the patient Assisting the patient with feeding if necessary

Diets Regular- normal or full diet based on the food plate Liquid diets Clear liquids all components are clear i.e. tea, gelatin, or broth Full liquids includes sherbet, eggnog, malted milk, milk and cream, plain ice cream Soft diets are low residue, mildly flavored and requires minimal digestion. Foods included are soups, cottage cheese, crackers, fish, white meat of chicken and turkey

Special diets Religious restricted Therapeutic –prepared according to the patient’s individual health problem

Therapeutic Diets Diabetic diet-prepared to maintain the patient’s blood sugar within normal limits Sodium restricted Calorie restricted Low fat-limits cholesterol Mechanically altered-consistency altered Mechanical soft pureed

Nutritional supplements Used for patients with high nutritional demands Provided between meals and are given for specific therapeutic purposes

Calorie Counts Performed to assess a patients food intake Food intake is recorded for three days or specified period and analyzed for nutritional adequacy and calories consumed Must accurate document food consumed Dietician uses data to develop a specific nutritional plan.

Dysphagia Difficulty swallowing food and liquids; occurs in patients with neurological problems and some other diagnoses such as cancer Clients who have had a stroke

Signs and Symptoms of Dysphagia Taking a long time before beginning to swallow Swallowing three or four times with each bite of food Frequent throat clearing or coughing Lack of a gag reflex or weak cough Difficulty controlling liquids and secretions in the mouth

Dysphagia continued Wet, gurgling voice Refusing to eat, spitting food out, or pocketing food in cheeks Unintentional weight loss Tightness in the throat or chest Feeling as if food is sticking in the esophagus or sternal area

Aspiration Precautions Positioning Upright at 60-90 degrees Head and neck flexed at midline Remain upright for at least 30 minutes after meals Feeder at or below eye level of patient

Aspiration precautions Environment Minimize distractions, adequate lighting, comfort level Amount and Rate ½ to 1 teaspoon at a time, pause between spoonfuls, verbal cues for additional swallows, no straws, use thickening agents, may need to decrease rate and amount of food toward end of meal Diet Check diet order, if patient can not tolerate stop feeding, post aspiration sigh above bed

Aspiration precautions continued Other Oral hygiene before meals, periodically throughout meal check to see if patient swallowing and can clear throat Do Not mix textures together Check mouth to see if pocketing food Follow recommendations by speech pathologist– chin tuck, head turn, effortful swallow, head tilt to right or left, alternate textures

Alternative nutrition Total parenteral nutrition Enteral feedings

Disorders requiring TPN/Enteral nutrition Cancer Ulcerative Colitis Crohn’s Alzheimer’s Disease ALS MS/MD Parkinson’s Disease Aspiration risk

Disorders requiring tube feeding Cancer Ulcerative Colitis Crohn’s Alzheimer’s Disease ALS MS/MD Parkinson’s Disease Aspiration risk

TPN

Total Parenteral Nutrition Total parenteral nutrition (TPN) supplies all daily nutritional requirements. TPN can be used in the hospital or at home Because TPN solutions are concentrated and can cause thrombosis of peripheral veins, a central venous catheter is usually required.

Types of Feeding Tubes Nasogastric: Placed at bedside/OR Short-term Actions: Check nares Mouth Care Monitor for coughing,sneezing, gagging,N/V,dysphagia HOB elevated Set-up/initiate feedings

Types of Feeding Tubes Gastric Tube: Placed surgically/endoscopically Long-term usage Actions: Check site of tube for irritation/breakdown Clamp tube when not in use Tube free of pressure Set-up/initiate feedings HOB elevated Check for complications

Feeding Options Continuous Feeding: Feedings given via pump at controlled rate ordered by MD Administration may be 24 hrs or throughout the night only Tube feeding formula needs to be at adequate level to ensure continuous flow (No more than two cans in bag at once) HOB elevated Use appropriate tubing

Feeding Options Bolus: Large amount of formula administered as ordered-- q 3- 4 hrs Administered by staff Accurate measurement of ordered formula Administer at appropriate controlled rate FINAL flush is critical HOB elevated during and after feeding

Effects of Tube Feeding Loss of dignity Loss of sensation and texture of food Inability to share social connection with family/friends Inability to choose diet Anger Possible risk of aspiration/infection

Charting the I & O

Recording Intake and Output Perform on patients who: Are dehydrated Are receiving IV infusions Have recently had surgery Have a urinary catheter Are perspiring profusely or vomiting Have a specific diagnosis requiring Intake and output

Fluid intake May be either encouraged or restricted depending on patient condition Estimate intake by knowing liquid container amounts

Intake measurements 1 0unce= 30 cc Sherbet cup or Ice cream cup= 120 cc Jello = 130 cc Popsicle = 70 cc Juice prepack =120 cc Soft drink = 360 cc Broth =180 cc Coffee= 240 cc Milk carton= 240 cc Iced tea = 240 cc Hot cereal =180 cc

Intake and output (I&O) is the measurement of the fluids that enter the body (intake) and the fluids that leave the body (output). The two measurements should be equal. (What goes in.... must come out!) The metric system is used for fluid measurement. The measurements should be recorded in ml. (milliliters). The average adult intake is 2500-3000mL. per day. The average output is 2500-3000mL. per day. To convert from ounces to ml., multiply by 30 (Ex. 6 oz. x 30ml. = 180ml.) To convert from cc/ml to ounces, divide by 30 (Ex. 240cc / 30cc = 8 oz.)